Form Lic 421cc - Civil Penalty Assessment - Child Care Page 2
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2STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
CIVIL PENALTY ASSESSMENT – CHILD CARE
EXPLANATION TO LICENSEE
Immediate civil penalties shall be assessed against child care licensees for:
Not providing or obtaining signatures on the LIC 995B “Family Child Care Home Addendum to Notification of Parents’ Rights
(Regarding Removal/ Exclusion)” or the LIC 995C “ Family Child Care Home Addendum to Notification of Parents’ Rights
(Regarding Reinstatement)” to one or more parents/authorized representatives of children in care.
• See California Health and Safety Code Section 1596.8712(d)(1) and 1596.8712 (d)(2)
Not providing copies of the signed addendum identifying excluded individual(s) when requested by the Department.
• See California Health and Safety Code Section 1596.8712(d)(3)
Not posting the Notice of Site Visit Report, or any licensing report indicating a Type A violation, or Proof of Correction of a Type
A violation for 30 consecutive days.
• See California Health and Safety Code Sections 1596.817(b)(2), 1596.8595(a)(3), and 1596.8595(b)(3)
Not returning form LIC 300E, “Confirmation of Removal” from your facility/home to Licensing within five days.
• See California Code of Regulations Section 102370.1(b)(1)(B)
Second or subsequent denial of a parent or legal guardian to enter and inspect a facility or incident of retaliating against a
child, parent or guardian for any exercising of the right to inspect a facility, or for lodging a complaint against a facility.
• See California Health and Safety Code Sections 1596.857(b), and 1596.857(c)
You will receive an invoice in the mail once administrative appeals have been exhausted. Payment is due upon receipt of
invoice. Unless payment arrangements have been made that are acceptable to the Department, a civil penalty not paid within
30 days of being billed will be subject to late fees. Payment must be made by check or money order made payable to the
“California Department of Social Services”. Please write the facility number and invoice number on your check.
DO NOT SEND CASH.
NOTE: In addition to the imposition of civil penalties, the California Health and Safety Code Section 1596.885 authorizes the
suspension or revocation of a license based on licensing violations.
APPEAL RIGHTS
The licensee has a right without prejudice to discuss any disagreement concerning the proper application of licensing laws
and regulations with the Department. The licensee may request a formal administrative review of any civil penalty or notice of
deficiency, to be conducted by the Regional Manager, adhering to the timeline below:
• Within 15 business days of receipt of this form, the licensee may request a formal review of any civil penalty or notice of
deficiency. The request must be made in writing and should be sent to the Regional Office of jurisdiction over the
facility. The licensee must include all available supporting documentation with the request for review.
• Within 30 business days of the request for review, the licensee may submit additional supporting documentation that
was unavailable at the time of the initial request.
• Within 30 business days of receiving the initial request from the licensee, the Department may request additional
information from the licensee deemed necessary to make its determination. The licensee shall provide this additional
information within 30 business days of receiving the request from the Department.
• Within 60 business days of the date when all necessary information has been provided to the Department by the
licensee, the licensee shall be notified in writing of the Department’s decision.
The Department has a duty to review the facts presented without prejudice. Upon review of the facts, the Department may
amend or dismiss the civil penalty or finding of deficiency.
Within 15 business days of receiving the Regional Manager’s decision, the licensee may further appeal the decision to the
Program Administrator. The same timeline as above applies. The Program Administrator’s decision is considered final, and
concludes the licensee’s administrative appeal rights.
LIC 421CC (8/17)
PAGE 2 OF 2
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